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General NPI Number Information
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NPI Number | 1225394190
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Entity Type | Organization
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Legal Business Name | EDWARD BILLIE
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 27 EAST ST APT 2
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City | HARTFORD
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State | CT
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Zip | 06120
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Country | US
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Telephone | 860-833-3027
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Fax |
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Provider Business Mailing Address
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Address Line | 27 EAST ST APT 2
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City | HARTFORD
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State | CT
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Zip | 06120-2651
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPUETIC MENTOR
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Name | MR. EDWARD BILLIE I
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Credential |
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Telephone | 860-833-3027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | CT
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